Elevate Bridgeport

Welcome Back Bash!

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Student's First Name

Student's Last Name

Student's Phone Number

Student's Email

Parent/Guardian Full name

Parent/Guardian Phone Number

Parent/Guardian Email

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I give my child permission to attend Elevate Bridgeport's Welcome Back Bash

I hereby grant Elevate Bridgeport permission to use my likeness in a photograph, video, or other digital media in any and all it's publications and social media.